Form No.

CH/203

TEST REQUISITION FORM (Chemical & Analytical Division)

Company Name:
Billing Name:
Address:

Navyug laminates
Navyug laminates
C-124,Focal Point,Phase-5,Ludhiana,141010,Punjab

Contact Person:
Mr.Anuj Seth
E-mail ID:
labvepl@gmail.com
91-161-5209900
Telephone:
(Ext)() Fax:
Sample Description:
WNW 450
No. of Sample:
1
Fibre Content:
Buyers Name:

Order No.:
Buying Agent:

Style No.:
Contact Person:
Mr.Anuj Seth
Colour:
E-mail ID:
anujseth@versatilegroup.in
End Use:
Season:
Manufacturers
Name

Country of Destination:

Official Use Only

Rpt. No.:
Job No.:

A/c No.:
Wool fabric

Black

Test(s) Required: (Please tick appropriate boxes)

AZO DYE

SALT SPRAY / CORROSION TEST

Others:

PCP / TeCP / TriCP CONTENT

TOTAL LEAD IN SURFACE COATING

OPP CONTENT

TOTAL LEAD / TOTAL LEAD IN SUBSTRATE

FORMALDEHYDE

NI SPOT TEST

PVC IDENTIFICATION

NI RELEASE TEST

BHT FREE (QUANTITATIVE)

TOTAL CADMIUM CONTENT

ALLERGENIC DISPERSE DYE

CADMIUM IN SURFACE COATING

CARCINOGENIC DYES

CHROMIUM VI

Test method to be followed:

PHTHALATES

CHROMIUM VI WITH AGING

APEO (NP/NPEO/OP/OPEO)

TOTAL NICKEL CONTENT

EN

PFOS / PFOA

EXTRACTABLE HEAVY METAL

AATCC / ASTM

CHLORINATED ORGANIC CARRIERS (COC)

HEAVY METAL IN PACKAGING (CONEG/TPCH)

ISO

DIMETHYLFUMARATE (DMFu)

ORGANOTIN COMPOUNDS

BS

DIMETHYLFORMAMIDE (DMFa)

SHORT CHAIN CHLORINATED PARAFFINS(SCCP)

Others (to be specified)

SHOE COMPOSITION

TRIS / TEPA

POLY AROMATIC HYDROCARBONS (PAHs)

BISPHEONOL - A

LEACHABLE LEAD AND CADMIUM

SVHC (REACH)

Comment

FOOD GRADE TESTING (SPECIFIED TEST NAME)

Yes

No

(Unless specified, all tests will be conducted in accordance with the rest methods / standards appropriate to the final export destination of the goods).
Service Required

Regular

Report Delivery Service:

Yes

Express (48 Hours, 50% Surcharge)

Shuttle (24 Hours, 100% Surcharge)

No

Return Remained Sample:

Shuttle (200% Surcharge)

Yes

No

We request for the above tests and agree that all testing will be carried out subject to INTERTEK INDIAS scale of charges as set forth in their
prevalent price list of which we have seen a copy and upon and subject to the terms and conditions set out hereon and overleaf.
Authorized Signature
Date.and Company Rubber Stamp .
(P.T.O. for terms and conditions)

Notes:

CH/121

1. Photocopy of TEST REQUISITION FORM will NOT be accepted byINTERTEK INDIA PVT. LTD.
2. Client should retain the DUPLICATE for own reference and present the same for collection of test report in our office.
3. No comment may be given for some of the test items if related standard or specification is not available.
Intertek India Pvt. Ltd.
290, Udyog Vihar, Phase II, Gurgaon, Haryana - 122 016
Tel: +91 124 450 3400 Fax: +91 124 450 3470

INTERTEK INDIA PVT LTD.

CH/121